Amputees: Limb Fitting

Debate between Baroness Manzoor and Baroness Thornton

Thursday 2nd May 2019 Lords Chamber

[Baroness Manzoor]

I thank my noble friend for his support for the NHS. I hope that his new knee continues to work effectively and properly for a very long time.

[Baroness Thornton (Lab)]

My Lords, I have two questions for the Minister. First, many people face an amputation as a result of diabetes. What progress is the national prevention programme making in reducing the number of amputations? Secondly, the Minister will know that NHS England organised a patient survey last year. It reported that one of the biggest issues for people was getting a comfortable and timely socket fit. People expressed frustration that it was not always a get it right first time situation. That is vital, so my second question is about quality control as well as collecting data.

[Baroness Manzoor]

I thank the noble Baroness. NHS England invested more than £9 million of transformation funding in 2017-18 to further reduce amputation rates in people with diabetes by putting in place new and expanded multidisciplinary footcare teams. Overall, the incidence of major amputations in England is now one of the lowest internationally because of this investment. As the noble Baroness correctly said, a review was undertaken. Clinicians will look at the outcomes of that review and take the appropriate action in due course to ensure that some of the complaints made have been addressed adequately.

Health Services (Cross-Border Health Care and Miscellaneous Amendments) (Northern Ireland) (EU Exit) Regulations 2019

Debate between Baroness Manzoor and Baroness Thornton

Thursday 21st March 2019 Lords Chamber

[Baroness Thornton]

I hope the Minister does not mind, but while she was speaking I went to GOV.UK to have a look. She is quite right that there is a lot of information there, but if I want to know about healthcare in France or wherever, I will go to the NHS website. That is the first place I would think of going. If I want to know about my passport or that sort of thing, I would go to GOV.UK or the Home Office. There is a really serious communication issue here that the Government must take seriously very quickly.

[Baroness Manzoor]

My Lords, I take the issue very seriously because communication is key, particularly in the healthcare industry where there are very vulnerable people. It is right that we make information available in an easy, clear format. I am grateful to the noble Baroness for checking that out. She makes a valid point. I will feed her comments back to the department and, if we are able to do so, we will put the information on the generic website because I suspect that I, or anyone else, would go to the NHS pages as well. It seems the most logical thing to do. She has seen the webpage, I have not, but I will take her comments back. I hope the noble Baroness is reassured—she is nodding.

These two instruments and the Healthcare (International Arrangements) Bill will give us the best possible chance of ensuring that there is no loss of reciprocal healthcare arrangements for UK citizens in the EU, the EEA and Switzerland.

Motion agreed.

Nutrition (Amendment etc.) (EU Exit) Regulations 2019

Debate between Baroness Manzoor and Baroness Thornton

Thursday 21st March 2019 Lords Chamber

[Baroness Manzoor (Con)]

My Lords, this statutory instrument has been laid to ensure that, following our exit from the European Union, the people of the United Kingdom can continue to benefit from the same world-leading standards of safety and quality for nutrition regulation as they do today. Primarily, successful passage of this SI will provide certainty for businesses and the public by ensuring a functioning statute book of nutrition legislation when the UK leaves the EU. It is no secret that both the Government and Parliament have shown a clear preference against a no-deal outcome. However, the Prime Minister has been clear that it will continue to be appropriate to prepare for a no-deal scenario, and this remains a priority for the Government. The EU is stepping up its preparations for no deal and it would be irresponsible for the UK not to do the same.

This SI provides all the necessary legislative building blocks to ensure readiness on exit day in all scenarios, guaranteeing that this aspect of nutrition legislation will continue to operate at the same high standard as it does now long after we exit the EU. The instrument covers the following aspects of nutrition legislation: the health or nutritional claims that food manufacturers can make for the foods they produce; the vitamin and mineral substances permitted for use in food supplements; the vitamins and minerals that can voluntarily be added to fortify foods, such as to breakfast cereals or soft drinks; the content of foods for specific groups, such as young children; foods that are used for special medical purposes, such as those for people recovering from illnesses; and total diet replacement foods for weight control.

Changes made through this instrument are largely technical in nature, amending EU-specific references in retained EU and domestic law which will no longer be applicable when the UK withdraws from the EU. Perhaps the most important change made by this SI is the transfer of powers currently held by the European Commission to the Secretary of State, Scottish Ministers, Welsh Ministers and, in relation to Northern Ireland, the Department of Health as applicable, ensuring that the UK reclaims full legislative control in this area. The SI also ensures that all applicable registers, annexes and lists will apply effectively in UK law as they stand on exit day. This has the explicit aim of mirroring the existing regulatory system, ensuring minimal disruption to industry and delivering continuity for both businesses and consumers.

Crucially, this SI provides for the transfer of functions in nutrition and health claims applications from EFSA, the European Food Safety Authority, to an expert committee in the UK. To guarantee minimal disruption, my department has been working closely with Public Health England to establish the new United Kingdom Nutrition and Health Claims Committee. The UKNHCC would replace EFSA’s Panel on Nutrition, Novel Foods and Food Allergens, and assume responsibility for providing independent scientific opinion on any new nutrition health claims submitted for use in the UK to the four UK Administrations. The committee would operate in a similar way to and to similar timescales as the current EFSA process, providing further continuity to business.

I am pleased to report to the House that, since the debate in the other place, excellent progress has been made in establishing the committee. Earlier this month, following the open and transparent recruitment exercise, appointment letters were issued to eight exceptional individuals selected from a number of high-calibre applicants. Further details of these appointments will be available in the public domain at the point the committee is required. With an excellent panel and chair in place, I can confirm that the committee is ready to come into effect if required.

Given the scope of the instrument, the House might ask why food for special medical purposes developed specifically to satisfy the nutritional needs of infants, such as infant follow-on formula, do not appear to be covered. While delegated legislation relating to infants and infant formula has indeed come into force under EU regulation 609/2013 to enable food business operators to adapt to the new requirements, those regulations do not apply until February 2020. As this SI covers only legislation in force and applicable at exit day, it was not appropriate to include them in this instrument. However, I reassure the House that it is the Government’s full intention to bring forward domestic legislation mirroring this delegated legislation as closely as possible at the appropriate time. Until then, the existing compositional, labelling and advertising rules will continue to be enforced by statutory instruments already in place, and will not be affected by the UK’s exit from the EU.

As I stated earlier, this instrument, respectful to devolution settlements, provides for the relevant Commission powers to be transferred to the four Administrations and includes a power for the Secretary of State to make legislation for the whole UK with the consent of the devolved Administrations, which have been involved with the drafting of these regulations at every stage. I am grateful to them for all their efforts to ensure that our high standards for nutrition are maintained after EU exit.

For the purposes of maintaining free trade across the UK and to retain continued consumer confidence, it is important that policy consistency remains where possible, but that the potential for necessary and appropriate divergence which does not disproportionately impact on the UK internal market also remains. This is to reflect or respond to country-specific needs where risk assessment shows this is both necessary and proportionate to protect consumers, such as on public health grounds. Officials have therefore been working collaboratively across the UK to develop frameworks which will deliver a common approach to nutrition policy and ensure that devolved interests are taken into account in the formulation of new policy and future decisions taken within central government concerning nutrition.

Proposals underpinning this SI were subject to a public consultation during December. As no significant changes to the existing regulatory regime were proposed, costs to business were deemed to be below the de minimis threshold. Departments are not required to publish de minimis assessments. However, we conducted an equalities impact assessment and found no impact on any of the protected characteristics as defined in the Equality Act 2010. We are grateful to the broad range of stakeholders that responded to the consultation, including food manufacturers, trade bodies, a local authority and members of the public.

On 25 February we published our response, which detailed how respondents were supportive of our proposals but sought more detail on how they would work in practice. Appropriate guidance, which my department plans to publish via bulletins ahead of exit day, has been tested with industry via the Department of Business, Energy and Industrial Strategy’s business experts group. Having received excellent feedback on the draft, I am confident that it is fit for purpose, clearly communicates any changes in process and provides all the additional information respondents requested.

We know that this is an important area of legislation, with many thriving businesses operating in this space. I again assure the House that it is our overarching aim that the amendments made by this instrument provide continuity for businesses and ensure that, when the UK leaves the European Union, the exceptional standards of safety and quality for nutrition regulation will continue. These draft regulations were passed in the other place on 28 February. With the assurances I have given noble Lords, I hope that they will support this necessary legislation. I beg to move.

[Baroness Thornton (Lab)]

My Lords, I will speak briefly. I thank the Minister for proposing these regulations. I remember several years ago one of the issues we had to deal with in the European Union was that the thriving industry in the UK for nutrition, vitamins, minerals and substances was much more advanced than those of many of our European colleagues. The framework we are now looking at, and will be pulling out of, is very largely of our making. That standards will be transferred intact is not surprising, since we developed them 10 or 15 years ago in the UK; we did so partly because we wanted access to the markets of the European Union for supplements, vitamins and so on.

My first question is this: what will happen to those markets? After Brexit day, what will happen to this industry, where we have been leading in Europe? It is quite clear that the purpose of this SI is to remedy deficiencies in UK legislation relating to nutrition arising from the withdrawal of the UK from the European Union without a deal. The Explanatory Memorandum says, and the Minister repeated, that there would be a,

“low level of impact … on businesses”.

But no impact assessment has been made—although I accept that the results of the consultation came to that conclusion. It also says that some “administrative burden” will be placed on businesses. That is a matter of some concern, and one we would wish to keep under scrutiny. Some of these businesses are not huge corporations but are relatively small; any additional administrative burden is a matter of concern.

Healthcare (European Economic Area and Switzerland Arrangements) Bill

Debate between Baroness Manzoor and Baroness Thornton

3rd reading (Hansard): House of Lords
Tuesday 19th March 2019 Lords Chamber

[Lord Hope of Craighead (CB)]

I thank the Minister for Amendment 3. That was an important matter to clear up, and the way in which it has been done is entirely in accordance with the wishes of those who were concerned about the previous wording. We are most grateful.

[Baroness Thornton (Lab)]

My Lords, I thank the Minister for introducing these amendments and explaining their intent. With the exception of Amendment 3, they seek to make the Bill consistent and coherent, its intended scope now being the EEA and Switzerland. I checked on the meaning of Amendment 3; it looks to me like it does the trick, so I thank the Minister for that.

At this stage, given the uncertainties we face over Brexit and what might happen in the next 10 days, surely the Government take the view that right now we have to focus on the challenge before us: the healthcare needs of UK citizens. We need to think about their healthcare arrangements and leave other parts of the world to be considered in due course. That requires a decision by the Secretary of State, and everybody would understand if he felt that the Government had enough on their plates right now.

Indeed, the Secretary of State might have been reading my mind, because at 12:54 today—lo and behold—we received an update in the form of a Written Statement about the continuity of reciprocal healthcare arrangements in the event that we exit the European Union without a deal. I commend this Statement to all noble Lords and hope that they will read. I have one or two questions for the Minister arising out of it. The Statement says,

“We have proposed to EU member states and EFTA states that we should maintain the existing healthcare arrangements in a no-deal scenario until 31 December 2020 with the aim of minimising disruption to UK nationals and EU and EFTA states citizens’ healthcare provision”.


This relates to the passage of the Bill, because the discussions all took place in Committee and on Report.

The Statement went on to say that current arrangements could only continue if there was a deal and an implementation period. Previously, it was said that 27 bilateral agreements would have to be negotiated, so we welcome what the Secretary of State is saying, but I would like the Minister to clarify whether my understanding is correct.

Furthermore, in Committee, Members—including some on these Benches—suggested that UK nationals and others for whom the UK is responsible and who have applied for or are undergoing treatment in the EU prior to and on exit day should be recompensed for up to one year. The then Minister said that this would not be possible because it would place a huge financial and administrative burden on the NHS. She said:

“It would make it less likely that individuals would take the steps they need to, even if they were able to. It would undermine our approach to member states in negotiating reciprocal agreements”.—[Official Report, 19/2/19; col. 2255.]


However, it has to be said—and I welcome it greatly—that this Statement goes some way to meeting that, and suggests that the Government will be prepared to recompense and pay for the treatment of UK residents. I welcome that but seek some clarification from the Minister. The point is that the Secretary of State’s Statement really only reinforces the need for the amendments that this House has put forward and voted on at every stage of this Bill, and that the Government themselves brought forward and voted on at Report. The lengthy Statement addresses the healthcare issues that we face and merely underlines the importance and urgency of sorting this matter out whichever way things go.

[Baroness Manzoor]

My Lords, on behalf of my noble friend Lady Blackwood and myself, I thank all noble Lords who have contributed to the constructive deliberations and review of the Bill during its passage over the past weeks. In that time, it has been the subject of spirited and carefully considered debate, both inside and outside of this Chamber. As we approach the final leg, I would like, in particular, to offer my thanks to the noble and learned Lords, Lord Hope and Lord Judge; the noble Lords, Lord Patel, Lord Kakkar, Lord Lisvane, Lord Foulkes and Lord Marks; the noble Baronesses, Lady Thornton, Lady Jolly, Lady Brinton and Lady Wheeler; and my noble friends Lord Lansley and Lord Dundee, for their considered contributions to this important debate. I am also grateful to my noble friend Lord O’Shaughnessy, who has been an invaluable supporter of this Bill. I also thank my noble friend Lord Young and the Bill team for all their support and hard work. I fully acknowledge the invaluable role played by my noble friend Lady Blackwood in leading on this Bill.

This Bill has been subject to considerable scrutiny and continues to be so, as the noble Baroness, Lady Thornton, has just said. I am grateful to the noble Lords who sought to improve and strengthen this important Bill.

Healthcare (International Arrangements) Bill

Debate between Baroness Manzoor and Baroness Thornton

Report stage (Hansard): House of Lords
Tuesday 12th March 2019 Lords Chamber

[Baroness Thornton]

My Lords, I added my name to the amendment in the name of the noble Lord, Lord Clement-Jones, and I am grateful that he has made the argument so I do not need to repeat it. Of course, I spoke about this in Committee and, like other noble Lords, I was reassured at the time by the explanation given by the noble Baroness, Lady Manzoor. Since then, however, the Bill team has actually made available the Bill data processing factsheet, which is very useful. It explains things in great detail, so I wondered whether it might be a good idea if this was given to everybody involved with this Bill. I do not know whether the noble Lord has seen this, but it is a very useful piece of information. Otherwise, I was satisfied in Committee, and if the Minister answers the questions, I am sure that I will remain satisfied.

[Baroness Manzoor (Con)]

My Lords, I thank the noble Lord, Lord Clement-Jones, and the noble Baronesses, Lady Jolly and Lady Thornton, for tabling Amendment 14 and raising the issue of the lawful and responsible processing of data. I start with an apology to the noble Lord, Lord Clement-Jones. My noble friend Lady Blackwood did write to the noble Lord, and I am sorry that he has not yet received the letter. We will endeavour to send him another copy as soon as possible.

As my noble friend Lord O’Shaughnessy said—and I reassure the noble Lord, Lord Patel, that—data sharing is a necessary and crucial aspect of maintaining effective complex reciprocal healthcare arrangements, and the Government are committed to the safe, lawful processing of people’s personal data. There are, as the noble Lord said, safeguards in place in respect of processing personal data for the purposes set out under the Bill, for which the Bill makes express provision. The Bill makes it absolutely clear that it does not authorise the processing of data that contravenes UK data protection legislation.

Data processing will be permitted only for the limited purposes set out in the Bill. Personal data will be processed in accordance with UK data protection law—as the noble Baroness, Lady Thornton, observed—namely, the Data Protection Act 2018 and the general data protection regulation, which will form part of UK domestic law under the European Union (Withdrawal) Act 2018 from exit day.

I assure the noble Lords, Lord Patel and Lord Clement- Jones, and the noble Baroness, Lady Thornton, that the Caldicott principles are an important part of the governance of confidential patient information in the NHS and a guiding mechanism for organisations in how they should handle confidential patient information on a practical level. The NHS is expected to adhere to these principles.

Since 1999, NHS bodies have been mandated to appoint a Caldicott Guardian. These principles are therefore ingrained in the current operation of the NHS and confidential patient data handled by the NHS for purposes in relation to reciprocal healthcare will be subject to these principles. The principles are consistent with the requirements of the GDPR and a breach of the Caldicott principles would most likely amount to a breach of the GDPR and the Data Protection Act 2018. The principles are not intended for statute but are of real practical and operational importance when confidential patient information is processed. This will be the case when confidential patient information needed for reciprocal healthcare arrangements is processed.

It is also worth noting that reciprocal healthcare arrangements will not normally involve the processing of confidential patient information, except in particular circumstances, such as facilitating planned treatment. However, where this information is processed through reciprocal healthcare arrangements under the NHS, it must comply with UK data protection legislation. NHS organisations, as they do now, will be required to adhere to the Caldicott principles. The data ethics framework that the noble Lord, Lord Clement-Jones, mentioned sets out collective standards and ethical frameworks for how data should be used across the whole public sector, as well as the standards for transparency and accountability when building or buying new data technology. Where the framework refers to personal data, it consistently cross-refers to the principles in the GDPR, which is the relevant legislation that policymakers must consider when processing personal data.

Personal data processed for the purposes of reciprocal healthcare arrangements would therefore also take into account the data ethics framework. In addition, from 1 April 2019, the National Data Guardian will be put on a statutory footing and will therefore be able to issue formal guidance and informal advice to organisations and individuals about the processing of health and adult social care data in England. This will provide patients statutory independent oversight of the use of health data, with health bodies being required by law to have regard to the guidance issued by the National Data Guardian. This is another way in which NHS organisations in England which are processing data in respect of reciprocal healthcare will be monitored and personal data can be further protected as necessary.

It is important to note that express reference to these principles in the Bill would not provide any additional protections for personal data or confidential patient information, as the standard of protections required is the same as the existing data protection legislation already provided for in the Bill. I am grateful to the noble Baroness, Lady Thornton, and others for their support in observing this. Furthermore, as I have said, these principles already apply to NHS organisations and will continue to do so in respect of reciprocal healthcare. As a result, it would be inappropriate to put these in the Bill and I am therefore unable to accept the amendment. However, the Government have listened carefully to concerns surrounding the list of persons who can lawfully process data as a part of implementing new reciprocal healthcare arrangements under the Bill and have tabled an amendment on this issue.

Currently, the list of authorised persons under the Bill includes the Secretary of State, Scottish Ministers, Welsh Ministers and a Northern Ireland department, NHS bodies and providers of healthcare. Of course, over time, public bodies change, are reformed and refashioned, and functions are transferred between them in consequence. Clause 4(6)(e) gives the Secretary of State the ability to respond to such changes so that systems can operate efficiently and data can follow in an appropriate and lawful way to enable such operation. We propose, however, subjecting any regulations that add to the list of persons authorised to process data for the purposes of the Bill to the draft affirmative procedure. This would allow Parliament the opportunity to scrutinise authorised persons handling personal data while ensuring that the Government have the ability to guarantee that future agreements are administered in the most efficient way possible.

The Government are firmly committed to the safe, lawful processing of personal data, and to ensuring that patients have enforceable protections under data protection legislation. I hope, given my assurances that any data processing under the Bill would comply with the Caldicott principles and the data ethics framework as appropriate, that the noble Lord will feel able to withdraw the amendment.

The noble Baroness, Lady Thornton, kindly mentioned the factsheet. Of course, if it is useful, we would be very happy to put this in the Library. Officials do a tremendous job and I am very grateful to them. I hope, with the assurance I have given noble Lords, and the fact we are providing greater scrutiny, that the noble Lord feels able to withdraw the amendment.

--- Later in debate ---

[Baroness Manzoor]

My Lords, I am grateful to the noble Baroness, Lady Thornton, for her amendment and to the noble Baroness, Lady Brinton, and my noble friend Lord Lansley for their contributions. I am not sure I want to go down this route. However, if the noble Baroness, Lady Brinton, wants me to write to her to clarify the point she raised, I will certainly do so. From what I have seen, my noble friend Lord Lansley is correct in saying that we have a reciprocal agreement with the countries he mentioned, where money does not exchange hands.

I can reassure the noble Baronesses, Lady Thornton and Lady Brinton, that—as I indicate—the Government have listened to the need for greater transparency in the administration and implementation of reciprocal healthcare arrangements. I welcome the support around the House for our intentions. We understand the importance of presenting this information in a clear and accessible document, which is why we propose to go beyond the current reporting requirements. Our initial commitment to the DPRRC is contained in the amendment that the Government have tabled on this matter.

As I said, the government amendment directly addresses concerns raised by noble Lords. I hope it reassures noble Lords and demonstrates that we have listened to the clear request for increased scrutiny of the use of public money.

The amendment of the noble Baroness, Lady Thornton, would ensure that specific requirements are reported on. The detailed content of the financial report should—and could only—be determined, once reciprocal healthcare agreements have been made and technical and operational details are known. We do not know what these agreements may be in future. If we accepted the amendment, we would be placing a statutory duty on future Administrations to collect and report on data we have not yet agreed to exchange with other countries. This is not appropriate.

Our amendment is a more feasible way of reporting on future healthcare arrangements that does not pre-empt their nature or how they may be implemented, but still allows for transparency and accountability, which the noble Baroness, Lady Thornton, and other noble Lords seek. It is a baseline, and we intend to go further than just reporting on payments, but we cannot provide a statutory obligation to do so.

The Department for Health and Social Care is currently working to ensure that UK nationals can continue to access healthcare in the EU in the same way they do now, either through an agreement at EU level or through agreements with relevant member states. In either case, we will have to agree how eligibility is evidenced, how—and how frequently—that information is exchanged and the reimbursement mechanisms that will govern those new agreements. Such agreements will have to take into account the operational possibilities and limitations of each contracting party to ensure the smooth operation of reciprocal healthcare arrangements. This should include how NHS trusts in the UK can evidence eligibility for the treatment of non-UK citizens in the most efficient and least burdensome manner.

Once those administrative details are known, the Government will be able to speak confidently to the specific measures that can be reported on for each country. There is an annual reporting mechanism in the government amendment to provide such detail. I acknowledge that the amendment of the noble Baroness, Lady Thornton, is well meaning and agree with its spirit, but the level of detail proposed in it could constrain or create unnecessary burden when administering future healthcare arrangements that have not yet been negotiated.

It is in the interest of neither the Government nor Parliament to force unnecessary administrative burdens on the NHS, which the amendment could inadvertently cause. The level of detail required in the amendment may create new reporting requirements on front-line NHS services.

As always, should the noble Baroness wish, the Minister or others from the department would be very happy to meet her to talk further about the issues, once we have a clear understanding of future negotiations and how they progress. I hope I have reiterated the Government’s commitment to accountable financial reporting, and that the noble Baroness and other noble Lords feel reassured on our commitment to ensuring that sufficient and appropriate checks and balances are in place on reciprocal health agreements. I hope she will agree that her amendment, which places a statutory duty on future Administrations to collect and report on data we have not yet agreed to exchange with other countries, is inappropriate. I hope I have reassured her and other noble Lords and she feels able to withdraw her amendment.

[Baroness Thornton]

I thank the Minister. I said from the outset that this was a probing amendment and I therefore beg leave to withdraw it.

Human Bodies: Commercial Exhibition

Debate between Baroness Manzoor and Baroness Thornton

Wednesday 27th February 2019 Lords Chamber

[Baroness Manzoor]

My Lords, as I have said, written consent is deemed to be necessary in the UK. It is different for other countries. There are allegations and concerns about organs being removed from people who are being held, for instance, in re-education camps in Xinjiang province, though we do not have evidence to corroborate this. We are working closely with the HTA to ensure that consent is sought in line with the countries concerned.

[Baroness Thornton (Lab)]

My Lords, there is a much more fundamental ethical issue at play here. Leaving aside the need for cadavers and human tissue for scientific and medical training purposes—which is regulated by the HTA—it seems likely that all the exhibitions which use plasticised cadavers and foetuses for supposedly educational purposes could use modern materials and production to create the same exhibits. That begs the question: why use cadavers and human body parts at all? If the answer is that people want to see such things and will pay to do so, I remind noble Lords that people used to flock in their thousands to see public executions until 1868. Does the HTA exist to regulate what, in this case, is akin to ghoulish curiosity and its manifestations? What is the ethical position and who should be examining it?

[Baroness Manzoor]

My Lords, of course the ethical position is not one for government. The Government have made law and set up the Human Tissue Authority in primary legislation. The exhibitions that have been taking place are in line with the law. However, I understand the noble Baroness’s point, which is valid, and I have empathy with what she says.

Out of interest, I looked at the exhibition review and interview in What’s On: Your What’s on News and Culture Guide. This is what it wrote about the exhibition:

“Fabulously fascinating, incredibly informative, gloriously gruesome … Real Bodies The Exhibition is an unforgettable experience for sure”.


That is the other side—it is not my view, I am just saying—but I understand the noble Baroness’s point.

NHS: Workforce Implementation Plan

Debate between Baroness Manzoor and Baroness Thornton

Tuesday 5th February 2019 Lords Chamber

[Baroness Manzoor]

Yes, my Lords, I agree. Every nurse or midwife graduating will be offered a five-year NHS job guarantee within the region where they qualify. I might also say that an extra 5,000 places will be funded from 2019-20 for clinical placements—a 25% increase. From 2021, we will provide funding for as many places as universities fill—up to a 50% increase—and we are making training much more accessible with a new online nursing degree, costing students a lot less money than currently.

[Baroness Thornton (Lab)]

My Lords, could the Minister assure the House that, when the noble Baroness, Lady Harding, conducts her workforce review, she consults not only the BMA and the royal colleges but the trade unions representing the people who clean our hospitals and serve meals, and the porters, ambulance drivers, paramedics, receptionists and auxiliary workers? This includes Unison, Unite, GMB, the Chartered Society of Physiotherapy, the Society of Radiographers and so on.

[Baroness Manzoor]

My Lords, I cannot see my noble friend Lady Harding in her place, but of course NHS Improvement will consult at the widest level to ensure that views are gathered from all concerned.

Health: Public Health Grant

Debate between Baroness Manzoor and Baroness Thornton

Monday 4th February 2019 Lords Chamber

[Baroness Manzoor]

My Lords, local authorities and charities are doing an excellent job and I commend the work they are doing, but the Government are investing £16 billion during the current spending review period on the provision of local authority public health services. That is on top of funding for Public Health England and what the NHS itself spends, which includes over £1 billion on immunisation and screening programmes and £340 million in 2016-17 on vaccine stocks. I agree that local authorities do a great job in challenging times.

[Baroness Thornton (Lab)]

My Lords, can we return the Minister to the original Question? Does she agree that increasing spending for the NHS, including a prevention vision, in the 10-year plan while cutting funding for services that impact on public health is a false economy? Could she please explain to the House the dichotomy of saying, “We want to spend more money on public health”, but actually cutting public health spending? Frankly, I am stumped.

[Baroness Manzoor]

I think I have already answered the Question. The reduction in the grant to which the noble Baroness has referred is not a new cut, as I have already said. It was agreed in the 2015 spending review, in a difficult financial environment. Difficult decisions had to be made. Local authorities have been aware of these cuts for over a year and have been able to plan accordingly. I have already stressed the balance we have between prevention and ensuring we address that. We are going to be putting £4.5 billion into primary and community care services, in addition to the money we are already putting into current services.

Organ Donation (Deemed Consent) Bill

Debate between Baroness Manzoor and Baroness Thornton

Committee: 1st sitting (Hansard): House of Lords
Friday 1st February 2019 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I shall say just a few words. The noble Baroness, Lady Randerson, and the noble Lords, Lord Carlile, Lord O’Shaughnessy and Lord Lansley, have made the arguments extremely well, so there is no need to repeat them. I just make the practical point that if we want this on the statute book it has to be unamended. We can have these discussions— they are helpful—but that is the truth of the matter. We will all have received a briefing yesterday from Kidney Care UK, which stated that three people die every day waiting for a kidney. That is what we need to bear in mind.

[Baroness Manzoor (Con)]

I was expecting the noble Baroness, Lady Thornton, to talk for a little longer, so I thank her very much.

I thank my noble friend Lord McColl for initiating this discussion on the role of the deceased’s loved ones under the proposed new system. This is an important issue that has rightly been the focus of much of the debate in the other place and here. My noble friends Lord McColl and Lord O’Shaughnessy rightly stress the issue of trust. As both my honourable friend the Member for Thurrock and the noble Lord, Lord O’Shaughnessy, have confirmed on a number of occasions, the family will remain at the heart of the new arrangements, as now. I believe this reassurance has also been given in correspondence to my noble friend and has been confirmed by NHS Blood and Transplant’s medical director and national clinical lead for organ donation. I am happy to give further clarification on this point.

The legislation sets the framework for consent to organ donation and reflects what we already know—that most people support donation and agree that the decision of the potential donor should be paramount. We have, however, always said that, as now, organs and tissues will not be taken without full consultation with persons in a qualifying relationship—that is, the deceased’s close family and friends. There will always be a personal discussion between the specialist nurses for organ donation and the family. This is NHS Blood and Transplant’s current policy and will not change under the new system.

In addition to this policy, the Bill as drafted allows for a person in a qualifying relationship to the deceased to provide information about the deceased’s wishes on donation of their organs and tissues. This is an important safeguard, to find out what the deceased would have wanted and the best way forward. I remind the House that healthcare professionals have a duty of care not only to the patient but to the family. Specialist nurses for organ donations are highly trained professionals from an intensive care or emergency medicine nursing background. When nurses join NHS Blood and Transplant, they initially receive extensive training over a six-month period. This covers supporting families to make end-of-life care decisions, including on organ donation. A key focus of the training is to enhance their skills in supporting acutely bereaved and grieving families.

Sepsis: National Register

Debate between Baroness Manzoor and Baroness Thornton

Wednesday 30th January 2019 Lords Chamber

[Baroness Manzoor]

My noble friend is right. Data linkage will make it easier to identify those most at risk of infections and sepsis, and to get them treated much quicker. Once that data is available, we will ensure that clinicians and everybody else in the NHS has that information so that they can deliver treatment as quickly as possible.

[Baroness Thornton (Lab)]

My Lords, this is about leadership. When the Department of Health and Social Care decided to bear down on hospital-acquired infections, MRSA and C. difficile, and to collect the data and act on it across the NHS, it happened because it was led from the top of the NHS. Would it not be possible to bring the same determination to bear on sepsis in hospitals? We know that GPs have to record diseases and infections, so the infrastructure to do this is there. It requires the political will to make it happen.

[Baroness Manzoor]

My Lords, I can reassure the noble Baroness that the political will is there, and it is being done. This is what data linkage is all about—getting that data much sooner, with patients assessed much quicker than they have been in the past.

Brexit: Insulin Supplies

Debate between Baroness Manzoor and Baroness Thornton

Thursday 24th January 2019 Lords Chamber

[Baroness Manzoor]

Please—the Government take this issue very seriously and have put in place proper contingency plans. I am assured, as a diabetic, that those plans are suitable.

[Baroness Thornton (Lab)]

As the noble Lord, Lord Roberts, says, all analogue synthetic human insulin comes from outside the UK. The Government have already warned us that ports such as Dover and Folkestone will have greatly reduced capacity for at least six months if we crash out of the EU, and the stockpiles mentioned by the Minister will last six weeks—certainly not six months. In the circumstances of a looming shortage of life-saving medication, how do the Government plan to ration insulin? How will they decide who gets it and who does not?

Health: Medicines Shortage

Debate between Baroness Manzoor and Baroness Thornton

Tuesday 22nd January 2019 Lords Chamber

[Baroness Manzoor (Con)]

My Lords, the Department of Health and Social Care has well-established procedures to deal with medicine shortages. We work closely with relevant stakeholders, including pharmaceutical companies, to help ensure that risks to patients are minimised when they arise. Medicine shortages are an ongoing issue and we continue to introduce new strategies to help tackle this problem, including the recent introduction of a mandatory reporting requirement for industry to notify us of impending shortages.

[Baroness Thornton (Lab)]

I thank the Minister for her Answer. If Ash Soni, president of the Royal Pharmaceutical Society, says he says never seen so many common drugs—naproxen and even aspirin, for example—affected by shortages, the complacent response from the Government seems inappropriate. It appears there may be many reasons for the shortages, including the looming Brexit deadline. Would the Minister inform the House what the Government intend to do about the export licences that the Secretary of State grants for the parallel trading of drugs? If the pound drops—let us hope it does not do so, but it certainly is a possibility—it will create shortages and profiteering. What strategy do the Government intend to follow under those circumstances?

[Baroness Manzoor]

My Lords, the production of medicines is complex and highly regulated, as the noble Baroness says, and materials and processes must meet rigorous safety and quality standards. Supply problems can arise for various reasons, such as manufacturing issues, problems with the raw ingredients, regulatory issues and batch failures. I assure the noble Baroness that the Government are doing everything in their power to ensure that contingency plans are in place to address exactly the kind of issue she has just raised.

Breast Cancer: Women Over 73

Debate between Baroness Manzoor and Baroness Thornton

Tuesday 15th January 2019 Lords Chamber

[Baroness Manzoor]

Absolutely not, my Lords. Screening has to be evidence based, there are very clear criteria, and where there is a need, we will endeavour to do it. It is not about inequality or accessibility. If any lady, whatever her age, including women over the age of 73, feels that she has an issue when she is examining herself and there are abnormalities in the breast, she can refer herself to a GP or self-refer for screening. Women are openly and freely able to do it every three years and can be seen more often if the need arises.

[Baroness Thornton (Lab)]

My Lords, will the Minister please return to that question? My noble friend asked what value the state and the NHS are putting on the lives of older women, because they are not included in the screening programme. Surely that is a question that she and her colleagues need to ask themselves.

Dentistry: Children

Debate between Baroness Manzoor and Baroness Thornton

Tuesday 15th January 2019 Lords Chamber

[Baroness Manzoor]

My Lords, I agree that it is outrageous that 45,000 children are requiring operations due to tooth decay but, as the noble Lord will know, tooth decay is a preventable disease. Access to dental services for children remains high. Although NHS England recognises that it has further to go in some hotspot areas, 6.9 million children were seen by a dentist in the 12-month period ending 30 September. NHS England has a legal duty to commission primary care NHS dental services to meet local needs and to help patients who cannot find a local dentist who is taking on new patients. Patients in this situation can contact NHS England’s customer contact centre for assistance.

[Baroness Thornton (Lab)]

My Lords, it is to be welcomed that the 10-year plan includes a commitment to seeing more children from a young age form good oral health habits to prevent tooth decay. It is, however, in conflict with the cuts to our public health budget. Does that commitment in the 10-year plan mean that the Government will be investing in children’s oral health and, if so, how much are they going to invest and when will that commence? If the noble Baroness does not have those figures to hand, I would be grateful if she would write and tell me what they are.

[Baroness Manzoor]

My Lords, I do not have those figures to hand, but will write to the noble Baroness with them. Under the NHS Long Term Plan, NHS England will invest to ensure that children with learning disabilities have their needs met by dental services and will work with partners to bring dental checks to children and young people with a learning disability, autism or both in special residential schools. That is part of the 10-year plan, but I do not have the figures that the noble Baroness requested and I will write to her with them.

Quality and Safety of Organs Intended for Transplantation (Amendment) (EU Exit) Regulations 2019

Debate between Baroness Manzoor and Baroness Thornton

Wednesday 9th January 2019 Grand Committee

[Baroness Manzoor (Con)]

My Lords, I refer the Grand Committee to the comments that I made at the start of the first SI, which also extend to this SI. I beg to move.

[Baroness Thornton (Lab)]

My Lords, the Minister has probably now realised that the Grand Committee is not satisfied with the regulations, and it is highly unlikely that the Grand Committee will be satisfied with these regulations on organs, because they concern the cross-border trafficking of human organs. When I read these regulations, I wondered—and I have already asked the Minister to walk us through this on one occasion—how an organ which is in Spain will find its way to Manchester when a match is found. What new barriers will exist with regard to the regulatory framework, inspection, cost and travel if we crash out of the European Union? When we are talking about organ transplants, lives are at stake. I am therefore extremely concerned that we will find ourselves with people not getting organs that match from other parts of Europe, or indeed with organs in the UK which should be in Ireland. I know that there is a great deal of trafficking of organs from hospitals across the Irish border. There are therefore some serious problems here, but they have been mentioned by many noble Lords in Grand Committee over the last three hours or so. I do not necessarily agree with the noble Lord, Lord Tyler, about unicorns, but on the other hand, these orders made me extremely worried that they are not deliverable. I hope that the Minister might on this occasion be able to convince us that they are.

Human Fertilisation and Embryology (Amendment) (EU Exit) Regulations 2019

Debate between Baroness Manzoor and Baroness Thornton

Wednesday 9th January 2019 Grand Committee

[Baroness Manzoor]

I have not given way. I am sorry but I need to finish. I need to make some progress. I have given way on a number of occasions, so forgive me.

The instruments are being made under the European Union (Withdrawal) Act 2018. They make appropriate amendments and revocations to correct deficiencies in UK law and retained EU law. Regardless of one’s views on EU exit, we can all agree that UK patients should have every opportunity to access the life-changing therapies covered by these regulations, such as: organs, including hearts to treat heart failure; stem cells used to treat blood cancers; corneas to restore sight or skin grafts to treat burns; and eggs and sperm to treat infertility.

Some organs, tissues and cells move between the UK and the EU. The proposed amendments are critical to ensuring that this movement can continue if we exit the EU without a deal in March 2019—and I stress again for noble Lords, if we leave without a deal.

A small number of organs are shared with EU and non-EU countries, with fewer than 30 organs on average being imported or exported each year. Tissues and cells are imported from and exported to EU countries less often than they are imported from and exported to countries outside the EU. There are around 5,000 imports of tissues and cells from the EU in a typical year. That includes around 600 imports of stem cells and 3,000 imports of bone products. The UK imports donated sperm, primarily from commercial sperm banks in the USA and Denmark.

To be clear, these instruments are limited to the necessary technical amendments to ensure that the legislation is operative on EU exit day. The instruments confer powers from the European Commission to the Secretary of State and the devolved Administrations to make technical changes. However, no policy changes are made through these regulations and we have no intention of making any at this point. I hope that that reassures noble Lords.

The main changes that these instruments would introduce are as follows. First, in the event of no deal, the UK and the EU will consider each other to be third countries; the regulations redefine the term “third country” to include EU countries and Gibraltar. As a result, licensed establishments will need to make administrative changes to continue to import organs, tissues and cells from EU countries and Gibraltar. For example, establishments may need to put new agreements in place with their EU supplier.

Secondly, the regulations amend a number of references contained in current UK legislation that will no longer be appropriate once the UK withdraws from the EU, such as references to obligations with which the UK must comply as an EU member state. For example, the instruments remove the obligation for UK regulators to share information on serious adverse incidents with the European Commission, as this was meant to be a reciprocal obligation of information sharing and we cannot keep an obligation that can be fulfilled by only one side. However, licensed establishments that exchange organs, tissues and cells with the EU will still have the obligation to report any serious adverse incident that may have affected their quality and safety to the UK regulators within 24 hours. That obligation extends to activities carried out in the EU.

[Baroness Thornton (Lab)]

Can the Minister clarify something for me? I may have missed something. Who is the obligation on? Is the obligation on the EU to tell us, us to tell the EU or both?

[Baroness Manzoor]

Both.

[Baroness Thornton]

That is rather important.

[Baroness Manzoor]

Yes, it is critical. The obligation applies to both sides within the 24-hour period I mentioned. UK regulators will therefore continue to receive information on serious adverse events.

[Baroness Thornton]

I want further clarification on that point. Why will the EU be obliged to tell us things if we crash out?

[Baroness Manzoor]

Obviously, our licence and the agreements we have in place will enable that to happen on both sides. We hope that those close partnerships will continue after we exit if we exit with a no-deal agreement.

--- Later in debate ---

[Baroness Manzoor]

My Lords, I am very much a newbie so I offer my sincere apologies if I have misunderstood. However, my understanding is that all statutory instruments go back to the House and any Member can get up and ask for a vote. It is not simply a nod from the House. The noble Lord is fully aware of that and I have heard him say so himself in the Chamber.

[Baroness Thornton]

Perhaps we could have some clarification from the Deputy Chairman of Committees.

[The Deputy Chairman of Committees]

Perhaps I can help the Grand Committee. I should remind noble Lords that the Motion before them is to consider the regulations. I must emphasise the word “consider”, not to approve them. Whatever happens in the Grand Committee, the Government will need to table an approval Motion in the Chamber where any Member can properly register disagreement and table an amendment to debate the Motion.

--- Later in debate ---

[Baroness Manzoor]

Perhaps that sounds flippant, but they will still be flying. This is a very serious and crucial matter. We are talking about patient safety and organs. We need to ensure that organs can get from point A to point B. I and the Government have made a commitment that they will be given priority. I do not have a crystal ball and I do not know what will happen; I do not know what will happen next week. What I am saying is that we want to support patient safety and the quality of the service at their current levels.

[Baroness Thornton]

I think that the Minister is being teased somewhat by my noble friend, but some of that is completely justified. Of course, the truth is that this is a Brexit-blind question because airports can be closed. I can remember dealing with this when I was a Minister and there was an active volcano in Iceland which stopped organs from being flown over from Canada. Perhaps I may offer that little bit of comfort to the Minister and suggest that perhaps she might move this statutory instrument.

[Lord Winston]

Before my noble friend finishes, I should say that I really do not feel that that is a satisfactory point. I hope that I will be forgiven for saying this, but there are numerous examples of where the immediate relationship with Europe is important. Let me take one of those which I do not believe has been considered at all. We are aware that the Human Fertilisation and Embryology Authority undertakes to consider that no more than 10 attempts at sperm donation are made by individual donors, but we have increasingly been importing gametes from outside the United Kingdom because the regulations in this country have rather prevented males wishing, not unreasonably, to donate their sperm. As a consequence, we are importing sperm at an increasing rate and there is a great deal of evidence to show that there is an increasing risk of consanguinity in offspring because more than 10 children are produced as a result of one donor selling their sperm in different countries. That is the sort of thing which does in fact apply to the Brexit situation and it is a problem.

The three statutory instruments before us for discussion are so technical and so demanding that the suggestion which has already been made that we should perhaps withdraw them for the time being and have a proper consultation on what is important in the Brexit issues might be something that we should be thinking about today before accepting them en bloc and before we proceed any further.

Human Tissue (Quality and Safety for Human Application) (Amendment) (EU Exit) Regulations 2019

Debate between Baroness Manzoor and Baroness Thornton

Wednesday 9th January 2019 Grand Committee

[Baroness Manzoor (Con)]

My Lords, I have nothing further to add to what I said at the start of the previous SI. I beg to move.

[Baroness Thornton (Lab)]

My Lords, I will not repeat the remarks I made on the previous statutory instrument about the cost, the waste of time and expertise, and so on of the exercise that we are going through. Instead, I will make a few points about this particular instrutment.

European Union safeguards on public health set high standards for the quality and safety of human cells and tissue. I thank the Brexit Health Alliance for its briefing on this subject, because it and I agree that the continuation of the UK’s alignment with these standards is in the interests of citizens on both sides of the European Union/UK border. I do not know what is going to happen next, so I will not speculate. It is clear that it is in the interests of citizens that we get this right. In the UK, we have the Human Tissue Authority, an experienced regulatory body which, one assumes, will continue to be resourced and to work to the same safety standards as before exit.

The issues I raised concerning embryology cross over to the issue of human tissue, and are about inspectors, the safety of premises, the cost and how tissues will cross borders when the UK becomes a third country. I can see from the regulations and the Explanatory Note what the Government think will happen to tissues and organs, but perhaps the Minister could walk us through what will actually happen. Will tissue that is needed in the UK from, say, Spain be able to reach the person who requires it without let, hindrance or regulation? That—and I will say the same on the next SI on organ donation—seems to be the crux of this issue for the ordinary person: whether or not these regulations will allow that traffic to take place with the same ease as today. If it cannot and does not, then these regulations will not work.

--- Later in debate ---

[Baroness Thornton]

I am grateful to noble Lords for being here because working on statutory instruments has felt quite lonely at times; this is my third or fourth set. I have become increasingly concerned, as I have shared with some of my colleagues. These three statutory instruments in particular give me enormous cause for concern, borne out by the Committee’s comments during the debate—particularly those of my noble friend Lord Winston. Along with her colleagues, the Minister has some serious problems. As I have said to anyone who would listen in the past few weeks, this is written across different subject areas; patents, which we will discuss later, is one example, as well as food security, which my noble friend Lady Jones has been waxing lyrical about. It is written across every single aspect of our life. In that way, our discussion today is important indeed. I do not envy the Minister.

[Baroness Manzoor]

I thank noble Lords. The discussion has been constructive. Many issues were raised, although, as I said in the previous discussion, many of them are outwith the comments I can make. As I said in the debate on the previous SI, my comments relate to all three of them—noble Lords will forgive me if I do not repeat myself—because this is about contingency planning and the specifications are not that different.

A number of noble Lords, including the noble Lords, Lord Foulkes and Lord Tyler, and my noble friend Lord Deben—forgive me if I have forgotten anyone—asked about what will happen in the case of a deal. Again, I want to make it clear that the SIs will be revoked or amended as necessary, depending on the deal. This is just about contingency planning, nothing more. We want only to maintain safety standards and ensure that these services can be provided where they are needed.

National Health Service: Nurses

Debate between Baroness Manzoor and Baroness Thornton

Tuesday 8th January 2019 Lords Chamber

[Baroness Manzoor]

I recognise the point made by my noble friend and she is right to say that we need a diversity of people coming in to the profession. We have plans to train up to 5,000 nursing associates through the apprenticeship route through 2018 along with up to 7,500 in 2019. That offers a foundation course from which student nurses can move into other areas, involving either further apprenticeship or nurse degree courses.

[Baroness Thornton (Lab)]

Following the question the Minister answered about the European Union, while I am happy that she has confirmed that nurses from the EU are still welcome, what about the proposed threshold of £30,000, which I gather is in the immigration purposes, when the average starting pay for a nurse is £23,000? Perhaps the noble Baroness could enlighten the House on what is happening in the discussions between her department and the Home Office?

[Baroness Manzoor]

I would like to reassure the noble Baroness that we work very closely with the Home Office. As a transitional measure, our temporary workers route will allow employers to bring in migrant labour at all skill levels for short periods, subject to strict conditions. Many jobs in the NHS, along with senior care roles, are still at skill levels above RQF 3, which is the equivalent of A-levels. Migrants will be able to come to the UK through our new skilled worker routes. We will also be asking the Migration Advisory Committee to keep salary levels under review. However, at the moment, as far as I am aware, there are no plans to curtail those.

Human Fertilisation and Embryology Act 2008: Frozen Eggs Storage

Debate between Baroness Manzoor and Baroness Thornton

Thursday 12th July 2018 Lords Chamber

[Baroness Manzoor]

My Lords, when the 1990 Act was reviewed, the 2005 Green Paper consulted specifically and asked views on whether the time limit should be changed, and what new limit would be appropriate. There was no consensus among the responses on what a new limit should be, with a wide range of storage periods being suggested, from 10 months to 20 years. I am not aware of any consensus now of what would be a more appropriate maximum storage limit. When the 2009 regulations were put in place, they were considering the potential storage needs of adults.

[Baroness Thornton (Lab)]

My Lords, it seems to me that the Government are at sea and are having a problem with this area of regulation in two different ways. I declare an interest, as I have a niece who had cervical cancer at a young age and had her eggs harvested. She has had a full recovery and those eggs will, we hope, be put to good use. The 10-year limit does not apply to her, which seems very arbitrary, so it seems to me that the Government have to review that. Do not the Government also need to review the regulation of the private clinics because they are not treating women well? So, there are two things. The noble Baroness, Lady Deech, is quite right that the limit needs to be reviewed, but the private clinics also need to be reviewed. Does the noble Baroness think that that is true?

[Baroness Manzoor]

As I have said, the Government will review any legislation if there is consensus and a need for it. Currently, there is not sufficient consensus on the period for storage. On private clinics, there are HFEA guidelines that women should attend clinics now registered by it, but it is a matter of personal choice as to where women seek treatment.

NHS Workforce: Mental Health

Debate between Baroness Manzoor and Baroness Thornton

Thursday 17th May 2018 Lords Chamber

[Baroness Thornton]

To ask Her Majesty’s Government what steps the Department of Health and Social Care and the National Health Service are taking to support the mental health of the NHS workforce in England.

[Baroness Manzoor (Con)]

My Lords, the NHS workforce is our greatest asset and their mental health is very important. Good mental health enables fulfilling careers and better care for patients. Through our NHS health and well-being programmes, the department is committed to ensuring that staff mental illness is prevented wherever possible and that staff are supported in self-managing their mental health. When needed, staff are offered quick access to psychological interventions.

[Baroness Thornton (Lab)]

I thank the Minister for that Answer. As noble Lords will be aware, this is Mental Health Awareness Week, and the Mental Health Foundation is focusing particularly on stress at work. Coming at the end of the winter crisis, which has put all NHS staff and care workers under pressure, and given the pressures put on staff by 100,000 posts in the NHS being unfilled—that is an NHS Improvement figure—I would like to ask the Minister two questions. First, will the Government seek to assess the stress put on NHS staff by the winter crisis when they eventually tell us the financial and patient price that has been paid over the winter period? Secondly, is the Minister aware of the irony that 75% of mental health workers have been stressed at least once a week due to staff turnover leaving them under extra pressure?

[Baroness Manzoor]

My Lords, the Government are committed to putting record levels of funding into mental health. We are totally committed to improving the health and well-being of our staff and to seeing mental health services improve on the ground. As the noble Baroness, Lady Thornton, will know, employers are also being supported by the first-ever common framework for NHS staff health and well-being. This was launched this week and includes mental health prevention, self-management and access to psychological therapies. She asked what we are doing about stress. As she will be aware, following the Boorman review, the NHS staff sickness absence rate reduced to 4.13% for the year to December 2017. However, I understand that more needs to be done in this area.

Employment Rights Act 1996 (NHS Recruitment—Protected Disclosure) Regulations

Debate between Baroness Manzoor and Baroness Thornton

Tuesday 1st May 2018 Lords Chamber

[Baroness Manzoor (Con)]

My Lords, we are committed to building a culture of openness and transparency in the NHS to help make it the safest healthcare system in the world. We want to ensure that those who work in the NHS feel safe to make a disclosure in the public interest. This is often called speaking out or “blowing the whistle”.

When Sir Robert Francis QC carried out his Freedom to Speak Up review in 2015, he recommended a number of changes to help create an open and honest reporting culture in the NHS. The Government have therefore responded to these recommendations, in particular by establishing an independent national guardian, Dr Henrietta Hughes, to support NHS whistleblowers and improve the reporting culture in the NHS. The national guardian’s office also provides leadership, training and advice for a network of over 560 “Freedom to Speak Up” guardians, based in all NHS trusts and foundation trusts.

Sir Robert’s review found that a number of people struggled to find employment in the NHS after making protected disclosures. He recommended that the Government should introduce protections for people seeking employment in the NHS on the basis that they had made a protected disclosure. The Government amended the Employment Rights Act 1996 through the Small Business, Enterprise and Employment Act 2015. New Section 49B gave the Secretary of State a power, through regulations, to prohibit certain NHS employers from discriminating against job applicants if it appears that the applicant has made a protected disclosure. The regulations are laid under that power.

The regulations give applicants a legal recourse through the employment tribunal or civil court, should they feel that they have been discriminated against, with appropriate remedies should their complaint be upheld. They also enable a job applicant to make a complaint to the employment tribunal and set a timeframe of three months within which a complaint to the tribunal must be lodged.

The regulations set out the remedies that the tribunal may or must award if a complaint is upheld. The employer may be ordered to pay compensation and the tribunal may recommend the employer to take specified steps. They also make provision as to the amount of compensation which may be awarded. An application to an employment tribunal under the regulations is subject to the early conciliation regime. This provides an opportunity to resolve the claim via the Advisory, Conciliation and Arbitration Service, known as ACAS. This should help to ensure that only cases that cannot be resolved through other methods are brought to the employment tribunal. The regulations also provide that discrimination by the NHS employer because the job applicant has made a protected disclosure is actionable as a breach of statutory duty. This gives job applicants additional protection, including the right to bring a claim, which would be in the civil courts, for breach of statutory duty, in order to, for example, restrain or prevent discriminatory conduct.

In summary, these regulations are an important step forward in improving the protections for NHS staff who speak up and will support our ambition to improve patient safety. I commend them to the House.

[Baroness Thornton (Lab)]

My Lords, I suspect this may be the Minister’s first statutory instrument, so I welcome her to the cohort of those of us who do this. I also congratulate her on her very good explanation of these regulations. I was a Minister when the first Francis report was produced, and I am very pleased to see these regulations before us. I have a number of questions of which I have given her warning. They are mostly based on the questions that my honourable friend Justin Madders asked last week when this matter was discussed in the Commons. I felt that the Minister there did not give adequate responses, so I am going to have another go. Let us hope we can do better this time.

I realise this is not pertinent to this statutory instrument, but why just the NHS? The Government need to think that there are other sectors, such as the financial sector, where whistleblowing protection is just as important and necessary. Additionally, these regulations do not apply to all NHS staff. There is partial protection for NHS workers. For example, are NHS England and the Department of Health and Social Care excluded? Why? Why are private providers within the NHS excluded from these regulations? What about pharmacies, clinical commissioning group workers, medical researchers and GPs’ surgeries? There must be whistleblowers in all those places and the staff in them surely deserve the same protection. What about staff who are transferred to wholly owned subsidiaries within the NHS? Will they be covered by these regulations? If not, why not?

The regulations apply across a range of issues in the NHS. Does the Minister recognise that by drafting regulations in this way the Government risk continuing rather than challenging the culture? While we might welcome the fact that Regulation 3 removes any restriction to action being available only in cases where a protected disclosure has taken place, we are concerned that the use of the phrase,

“because it appears to the NHS employer”,

might have the unintended effect of opening up a range of technical defences to NHS employers. Will the Minister consider, for example, an instance where a protected disclosure has taken place but the employer is able to argue that it did not appear to be a disclosure or even that it simply did not consider that a disclosure had taken place at all? This seems to be an anomaly involving the original whistleblowing legislation when an employee is dismissed or suffers detriment as a result of a protected disclosure and the regulations before us. An employee could find themselves without protection if it turns out that they have not made the disclosure but the employer has mistakenly concluded that they have. That appears to be at odds with the draft regulations, which suggest that it is irrelevant whether that individual has made the disclosure. The only consideration under the draft regulations is whether it appears to the trust that the disclosure has been made, so I would welcome any comments that the Minister might have about whether there are any plans to regulate this situation in the future, given that it will be for the court to interpret the employer’s belief and how the test is applied. Would not applicants be placed at a clear disadvantage requiring them to take expert legal advice?